The first education session Mr. Weiss will lead during the bootcamp, Introduction to Compliance, will outline ideal targets for coding compliance now and after the end of the pandemic public health emergency. “Unfortunately, the 1–3% of healthcare practices that engaged in fraudulent billing through the pandemic are part of the reason for this intense scrutiny by payers now.” This is requiring all practices to shore up any gaps or inaccuracies in coding that could open them up to audits, he adds.
The next session, Acts, Laws, Regulations, Statute, will provide the latest coding requirements, compliance regulations, legal changes and other rules dictating how federal and commercial payers are structuring required documentation for reimbursement. Mr. Weiss will also share what he is hearing from Washington, D.C., about trends in fraudulent claim litigation. For example, a recent ruling in the Fifth Circuit Court found that overbilling Medicaid was considered not only fraud, but “aggravated identity theft” with a mandatory minimum two-year prison sentence under a special statute.
After providing a solid understanding on the current rules for coding compliance, Mr. Weiss’ next session, How to Structure Effective Policies, will give individual practices of any size the tools to create coding policies that set them up for compliance success. “The key is to create a culture of compliance in your organization where effective policies and procedures specific to rheumatology are easy to implement,” he says.
His final two education sessions for the bootcamp will give practices more tools for safeguarding correct coding practices with discussion on Developing Internal Controls and Rolling Out Education for Staff. “When it comes to billing, education is essential for every person working in a rheumatology practice, because every element of practice management goes into accurate coding and documentation,” he notes. For example, it’s important that physician notes are accurate and complete and aren’t simply cut and pasted from the patient’s last visit, because such notes are scrutinized during audits.
Who Should Attend
Ideally, Mr. Weiss suggests that representatives from clinical, operational and billing areas in a practice should attend the bootcamp together, so current rules and needed updates can be understood as a team. “I’m excited to take the trends and outcomes of cases we are dealing with to bring relevant solutions to attendees,” he says. “I’m also eager to hear about challenges attendees are facing so we can discuss solutions in real time.”
